How the plastic surgery craze got under our skin

In many cultures visiting a cosmetic surgeon, rather than a cosmetics counter, is seen as the guaranteed way to reduce the signs of ageing. Photo / 123RF

Developed during the Great War, plastic surgery has changed the way we feel about the way we look. Harry Wallop reports.

An astonishing 20 million plastic surgery procedures were undertaken around the world last year, according to new figures published this week. In Brazil, 50,000 pairs of buttocks were augmented; in South Korea, 107,000 pairs of eyes were widened - many of them to be made more "Western"; in the US, 1.35 million women had their breasts enlarged; and 705 British men had their "moobs" (man boobs) removed. And don't even ask about all the labiaplasty in Germany.

These statistics, published by the International Society of Aesthetic Plastic Surgery, show how far the concept of beauty has changed in the last generation; they hint at how, in many cultures, visiting a cosmetic surgeon rather than a cosmetics counter is seen as the guaranteed way to reduce the signs of ageing.

The figures would no doubt horrify Harold Gillies, who 100 years ago forged a new field of medicine from the bloody trenches of Flanders: that of modern plastic surgery. The idea of grafting skin from one part of the body to another dates back centuries: "plastic surgery" as a term was coined in the 1830s (from the Greek plastikos - to be moulded), decades before "plastic" became a word to describe man-made materials. But as Roger Green, archivist for the British Association of Plastic and Reconstructive Surgeons (BAPRAS), says, the birth of plastic surgery as we know it can be dated to 1915.

Gillies was an ear, nose and throat surgeon who volunteered to serve in the Red Cross in Belgium. "He saw new injuries that were pretty horrific," says Green. Many soldiers had their faces hideously disfigured by shrapnel as they poked their heads above the parapet. Too severe to rectify with a skin graft, Gillies developed a technique called the tube pedicle, which involved cutting a strip of flesh from a healthy part of the body - usually the chest or forehead - but leaving one end still attached. The strip of skin was then "swung" into the new area and the flap folded in on itself, enclosing all the living tissue and blood supply, thus preventing infection. The result looked bizarre, but it worked. During the Battle of the Somme in 1917, Gillies treated 2,000 soldiers, mostly in this way.

During the Second World War, Archibald McIndoe, a pupil of Gillies, made further huge strides while treating burnt airmen. But it was not just technological advances - McIndoe's whole approach was novel. "While Gillies's mantra was 'As long as I can fix someone, that's OK', McIndoe was more bothered about the psychology of patients," says Prof Tony Metcalfe, director of research at the Blond McIndoe Research Foundation. East Grinstead, where McIndoe's hospital was based, became "the town that didn't stare".

This right to a "normal" life is something another pupil of Gillies has also pioneered, but for a very different type of patient. In Rio de Janeiro, Ivo Pitanguy, now 91, is known simply as "maestro" for his work in helping popularise cosmetic surgery among not just the yacht-owning classes but slum dwellers, too. Last year, more than 1.3 million had work done in Brazil. "Aesthetic surgery brings the desired serenity to those that suffer by being betrayed by nature," he has said.

Pitanguy argues that cosmetic surgery heals ailments such as low self-esteem, an idea that has certainly gained traction in some cultures - in particular highly aspirational and fast-growing economies like Brazil and South Korea, where an estimated 50 per cent of all women in their twenties have had work done. Many Korean girls are given a facelift by their fathers as a graduation present. This is not anti-ageing: it is about transforming your features to improve your chances in life. In some Seoul clinics, clients are asked as part of their consultation to complete a questionnaire. One question asks what they intend to do after successful surgery. The options? "Get a lover", "Find a job" or "Upload a selfie without using Photoshop".

In Britain cosmetic surgery is, mercifully, more regulated. And after a decade of huge growth, the trend is for less invasive work - tweaks, not tucks. Indeed, breast enlargement surgery fell by 23 per cent last year, with women put off by the PIP scandal in which many implants ruptured.

The British attitude is different from that in South America or Asia. "Patients don't want to look as if they have been operated on. They want to look healthier, brighter, but not necessarily much younger," says Paul Harris, council member of the British Association of Aesthetic Plastic Surgeons, adding that for his patients the most popular breast size is "a full C". For wealthy clients the ultimate sin is to look "done", like the "Bride of Wildenstein", the New Yorker Jocelyn Wildenstein, who spent a rumoured $4 million to look like a terrifying plastic cat. Or Jennifer Grey, the Dirty Dancing actress who bitterly regretted having surgery to straighten her distinctive nose. "I went in the operating room a celebrity and came out anonymous," she has said.

Now, after nearly a century of cosmetic surgeons stealing ideas from reconstructive plastic surgery, the flow of knowledge is going the other way. Fat transfer - pumping out fat from one area of the body and injecting it into the face, is a case in point. Developed by cosmetic surgeons, it is now used to reconstruct breasts after cancer surgery.

Fat transfers are "alchemy", says Nigel Mercer, president of BAPRAS, but they're still very risky: "The problem with fat is, it's got millions of stem cells. I mean millions." And with stem cells comes a far higher chance of cancer developing once again.

A century on, Gillies's pioneering work is still being used to help people rebuild their lives - as well as pump up their buttocks.

Timeline: 100 years of plastic surgery

1915: In a Belgian field hospital, Harold Gillies starts to reconstruct British soldiers' jaws and facial injuries.

1920: Rudolph Valentino, the silent movie star, has his ears pinned back, followed swiftly by Gloria Swanson having a facelift. An unbreakable bond between Hollywood and cosmetic surgery is born.

1941: Archibald McIndoe, who trained under Gillies, sets up the Guinea Pig Club of RAF airmen with terrible burns, who he was treating.

1962: Timmie Jean Lindsey from Texas, USA, becomes the first woman to receive silicone breast implants.

1987: The US dermatologist Jeffrey Klein introduces the "tumescent" technique for liposuction, allowing patients to have fat sucked out under local anaesthetic.

2005: Trials are undertaken in East Grinstead (at the hospital McIndoe founded) using spray-on skin cells to treat burns victims.